Clery Act Student Travel Form

This form is to be completed for any University-related overnight travel. That includes students such as athletics, academics, clubs/organizations, etc.

All fields marked with an asterisk (*) are required.

required text field

Group Name*

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Travel Contact Person

required text field

Advisor’s Name*

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Title*

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Department*

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Phone*

required email address field

Email address*

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Travel Dates

required date field

Lodging Check-In Date*

required date field

Lodging Check-Out Date*

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Lodging Facility Information

paragraph field

Note: If group is staying at more than one lodging facility, please complete a separate form for EACH facility (Hotel, campsite, cabin, etc.).

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Name of Lodging Facility*

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Street Address*

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City, State, Zip*

required textarea field

Specific floor(s), room number(s), or unit number(s) occupied*

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This trip is:*

A one-time trip

Repeated each semester

Repeated annually

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If trip is repeated, our group

Always stays at the exact same lodging facility

Uses various lodging facilities with each trip

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Comments

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Office Use

Link (required)